Mandhani Anil, Kumar Devendra, Kumar Anant, Kapoor Rakesh, Dubey Deepak, Srivastava Aneesh, Bhandari Mahendra
Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India.
J Endourol. 2005 Sep;19(7):797-802. doi: 10.1089/end.2005.19.797.
To critically assess the safety profile and complications of the transperitoneal approach to laparoscopic pyeloplasty at our center.
From January 2002 to January 2004, 92 patients with a mean age of 22.78 +/- 15.15 years (range 14 months-65 years) with primary (N = 90) or secondary (N = 2) ureteropelvic junction obstruction were treated by transperitoneal laparoscopic pyeloplasty and were evaluated for this study. Renal stones were present in eight patients. A double-J stent was placed antegrade in 50 patients and in the rest through cystoscopy. All patients were followed up clinically and by renal scan.
Of the 92 cases (93 renal units), 6 were converted to open pyeloplasty. Dismembered pyeloplasty was performed in 59, Fengerplasty in 8, and Foley Y-V-plasty in 20 units. A crossing vessel was present in 15 units (16.12%). The mean estimated blood loss was 63.6 mL (range, 30-200 mL). The mean operative time was 179.4 minutes (range 80-350 minutes). Overall, 17 patients (18.4%) had complications. Six patients had paralytic ileus and another six had increased drain output, which delayed the hospital stay to 7 days. Pyelonephritis and port-site hernia occurred in one patient each. Four patients required ancillary procedures: ureteroscopy for a migrating stent (1), percutaneous antegrade stenting (1), and SWL for residual stone (2). The mean hospital stay was 4 days (range 2-7 days). Of the 87 units (86 patients), 81 (93.3%) have shown improvement in symptoms and drainage pattern on renal scan at a mean followup of 12 (3-27) months.
The transperitoneal approach to pyeloplasty is safe and effective, although patients with large stone bulk and multiple stones should be considered for an alternative approach. The double-J stent should be checked carefully for proper placement. Hemostasis of the cut margin of the renal pelvis, watertight anastomosis, and adequate drainage should also be ensured.
严格评估我院经腹腔途径腹腔镜肾盂成形术的安全性及并发症情况。
2002年1月至2004年1月，92例平均年龄22.78±15.15岁（范围14个月至65岁）的原发性（n = 90）或继发性（n = 2）肾盂输尿管连接部梗阻患者接受了经腹腔腹腔镜肾盂成形术，并纳入本研究进行评估。8例患者存在肾结石。50例患者顺行置入双J支架，其余患者通过膀胱镜置入。所有患者均进行了临床随访及肾脏扫描。
92例（93个肾单位）患者中，6例转为开放性肾盂成形术。59个肾单位进行了离断性肾盂成形术，8个进行了芬格成形术，20个进行了弗利Y-V成形术。15个肾单位（16.12%）存在交叉血管。估计平均失血量为63.6 mL（范围30 - 200 mL）。平均手术时间为179.4分钟（范围80 - 350分钟）。总体而言，17例患者（18.4%）出现并发症。6例患者发生麻痹性肠梗阻，另外6例引流液量增加，导致住院时间延长至7天。肾盂肾炎和切口疝各发生1例。4例患者需要辅助治疗：输尿管镜取出移位支架（1例）、经皮顺行置入支架（1例）、体外冲击波碎石治疗残留结石（2例）。平均住院时间为4天（范围2 - 7天）。87个肾单位（86例患者）中，81个（93.3%）在平均随访12（3 - 27）个月时肾脏扫描显示症状及引流模式有所改善。
经腹腔途径肾盂成形术安全有效，不过结石体积大及多发结石患者应考虑采用其他手术途径。应仔细检查双J支架的放置是否合适。还应确保肾盂切缘止血、吻合口严密以及充分引流。
